Variations in Cause-of-Death Determination for Sudden Unexpected Infant Deaths

Abstract

OBJECTIVES To quantify and describe variation in cause-of-death certification of sudden unexpected infant deaths (SUIDs) among US medical examiners and coroners. METHODS From January to November 2014, we conducted a nationally representative survey of US medical examiners and coroners who certify infant deaths. Two-stage unequal probability sampling with replacement was used. Medical examiners and coroners were asked to classify SUIDs based on hypothetical scenarios and to describe the evidence considered and investigative procedures used for cause-of-death determination. Frequencies and weighted percentages were calculated. RESULTS Of the 801 surveys mailed, 60% were returned, and 377 were deemed eligible and complete. Medical examiners and coroners classification of infant deaths varied by scenario. For 3 scenarios portraying potential airway obstruction and negative autopsy findings, 61% to 69% classified the death as suffocation/asphyxia. In the last scenario, which portrayed a healthy infant in a safe sleep environment with negative autopsy findings, medical examiners and coroners classified the death as sudden infant death syndrome (38%) and SUID (30%). Reliance on investigative procedures to determine cause varied, but 94% indicated using death scene investigations, 88% full autopsy, 85% toxicology analyses, and 82% medical history review. CONCLUSIONS US medical examiners and coroners apply variable practices to classify and investigate SUID, and thus, they certify the same deaths differently. This variability influences surveillance and research, impacts true understanding of infant mortality causes, and inhibits our ability to accurately monitor and ultimately prevent future deaths. Findings may inform future strategies for promoting standardized practices for SUID classification.

A standardized postmortem protocol to assess the real burden of sudden infant death syndrome

“…SIDS epidemiology is in constant evolution, mainly because of prevention campaigns and improvement in diagnostic techniques but also due to different classification systems [14]. Several US publications about SIDS investigation focused the attention on the death scenario reporting and the cause of death certification by medical examiners and coroners, because of different jurisdictional system types and subsequent ample variability in case investigation practices [15][16][17]. Supra-national comparison of SUID and SIDS rates is even more complicated by the use of different death certification codes and the results are highly variable [18,19].…”

Adversarial childhood events are associated with Sudden Infant Death Syndrome (SIDS): an ecological study

“…Interestingly, SUID prevalence have not improved in the past decade [47], which attests to the limited success of the BTS campaign in actually preventing deaths [45]. Though SIDS prevalence decreases with time as more causes of deaths are becoming known with time, it may also decrease due to the variability in, and confusion about, categorizing deaths [48] or inconsistency between investigators [49]. The causes of death may also intentionally be misrepresented in order to avoid an autopsy due to cultural or religious practices or to avoid a time-consuming investigations [34].…”

„Plötzlicher Säuglingstod“ und „Anscheinend lebensbedrohliche Ereignisse“

“…B. akzidentelles Ersticken) registriert werden, was ihre epidemiologische Erfassung erheblich erschwert. So zeigte eine aktuelle Umfrage unter 800 US-Rechtsmedizinern und Leichenbeschauern, denen verschiedene Szenarien zu hypothetischen Todesfällen vorgelegt wurden, dass diese Szenarien zu ganz unterschiedlichen diagnostischen Zuordnungen führten [4].…”